protease, not all drugs of this type would produce this effect. On the other hand, hypertrophy was also observed in people taking medicines that did not include this type of antiretroviral drugs. Most protease inhibitors are ingested with a small dose of ritonavir, which serves to potentiate its effect. The blood concentration of these inhibitors, as well as ritonavir, can vary greatly between each person. Some doctors measure these blood levels for the purpose of adjusting the dose if necessary. Thus, the amount of drug ingested by some people may be lower, which can help reduce theirtoxicity. Some studies have also found that, with the same technique of measuring blood levels, the dose of efavirenz can be safely reduced (Sustiva®, Co-formulated in Atripla®), a fat-related drug, especially in the chest, in both women and men. Practicing exercise on a regular basis and following a balanced diet and low in saturated fat content could help lessen its impact. It can be reversed? Contrary to lipoatrophy, the results of studies on treatment changes to curb or reverse hypertrophy are not very clear. When the substitution of a protease inhibitor for a non-nucleoside analogue was tested, the other two drugs, ie nucleoside analogues, were not modified, something that might have helped. In some people improvements were observed after modifying one of the antiretrovirals by T-20 (Fuzeon®), a fusion inhibitor that is injected subcutaneously twice daily. There have also been cases in which the switch to atazanavir (Reyataz®) improved visceral fat, although its long-term impact on other symptoms of lipodystrophy is still being studied. Atazanavir is a protease inhibitor that, when ingested without ritonavir, has a very low lipid impact, although it is most commonly taken to ingestion with a small dose of it. The newIntegrase, Raltegravir (Isentress®), does not appear to affect lipids in the same way, but its true impact on lipodystrophy is not yet known. There are people with severe abdominal hypertrophy - when fat compresses the internal organs and compromises vital functions such as breathing or food intake - that may have been benefited by the growth hormone releasing factor (tesamorelin), a drug in the test phase which has not yet been approved. However, if no other intervention is performed, the fat reappears when the treatment with tesamorelin is finished. The topical use of testosterone gel has been helpful in some cases, mainly to reduce breast augmentation in men, an effect called gynecomastia. Also being tested is the benefit of using drugs to reduce blood fats (cholesterol and triglycerides), or to treat insulin resistance (with metformin). Some tests used to obtain other types of diagnostics may also serve to detect the early development of hypertrophy, such as magnetic resonance imaging (MRI). It allows to obtain a digital image of a cross section of the body. It is very useful to see the visceral fat that accumulates around the organs inside the abdomen. Repair hypertrophy In the case of fat accumulation may be done safely liposuction the following areas:
- Back of the neck, shoulders and back (buffalo hump).
- Chest, both men and women.
- Other accumulations located.